Understanding childhood epilepsy: etiology, clinical manifestations, risk factors and management strategies

Abstract

Epilepsy is among the most common serious chronic neurological disorders of childhood and carries consequences that reach well beyond the seizures themselves. Children with epilepsy are at increased risk of learning difficulties, behavioural and psychiatric comorbidity, and social exclusion and, in the most severe forms, premature mortality. The past decade has seen substantial change in how paediatric epilepsy is understood. The International League against Epilepsy (ILAE) has revised its definition of epilepsy and its frameworks for classifying seizures, epilepsies and epilepsy syndromes, while advances in neuroimaging and genomic sequencing have shifted the emphasis from describing seizures to identifying the underlying cause. This article reviews the current understanding of childhood epilepsy, with particular attention to its etiology, the clinical manifestations of the major seizure types and age-related syndromes, the risk factors that predispose to onset and recurrence, and the strategies used for diagnosis and management. Management is considered across the full treatment spectrum, from first-line antiseizure medication and emergency treatment of prolonged seizures to the ketogenic diet, neuromodulation, epilepsy surgery and precision therapies, together with the psychosocial care that determines long-term quality of life. Early and accurate syndromic and etiological diagnosis, rational treatment selection, timely referral of drug-resistant cases and attention to comorbidity are presented as the pillars of modern care. Persistent gaps, particularly in low-resource settings, are discussed.